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Dietary Sugar and Type 2 Diabetes Risk

Jun 2, 2018

Eating sugar and type 2 diabetes are linked in the public mind, but the association may be exaggerated, according to research: increased consumption of dietary sugars does not show increase risk of developing type 2 diabetes.

It is believed that increased consumption of dietary sugars can increase the risk for development of obesity and type 2 diabetes; however, this may not be all true. Sugar is not an essential food for body because it is mainly used as source of energy and does not have any other properties that contribute to nutritional well being. Sugar is added as an ingredient in solid or liquid foods as either sucrose or fructose. These two disaccharides are composed of glucose. When sucrose is consumed from food or beverage, it is broken down to free fructose and glucose. Both sucrose and fructose are metabolized similarly.

To date, many randomized controlled trials have been performed showing the effect of increased consumptions of sugar. An article published by Bray et al. showed that as availability of added sugar increased from 1980s to 2000s, there is a rise in overweight and obesity prevalence. Many trials have shown that increased consumption of calories from sugar leads to significant weight gain.  Although trials have showed that participants that received more sugar gained weight, it was also found that participants receiving less sugar did not show any significant weight loss. In addition, when sugar is replaced in an isocaloric exchange by other carbohydrates, there is not much change in the body weight. Few larger and longer duration trials have shown no association between increased consumption of sugar and body weight. Overall, most randomized controlled trials showed that sugar consumption itself does not cause weight gain.

Weight gain is believed to be dependent on total energy consumption and not just from sugar.

There is an evidence showing that many other sources of palatable calories can increase weight such as from consumption of potato chips, french fries, unprocessed meats, boiled or mashed potatoes. Studies that show that with increased consumption of sugar, there is increase in weight gain have failed to take other variables into consideration. Participants overall diet and lifestyle such as exercise or other health history should be taken into consideration to conclude relationship between sugar consumption and obesity.

Some investigators believe that sugar can stimulate appetite or reduce satiety. However, results of this statement have been found to be conflicting. A study was performed to test whether energy consumption before a meal can affect the amount of energy consumed at a meal. Results found that if a participant had consumed solid or semisolid food prior to meal then overeating was minimized during the meal. However, any liquid consumption of energy prior to meal did not affect total consumption of energy during a meal. This proves that sugar consumption prior to a meal does not lead to excess food consumption.

From studies, we know that weight gain is one of the major risk factor for development of type 2 diabetes. As mentioned above, consumption of dietary sugar alone does not appear to have significant role in weight gain. Meta-analysis and long term cohort studies have shown conflicting results on relationship between type 2 diabetes and sugar consumption. In fact, some studies have shown negative association for total sugars with diabetes. Overall, there is no solid evidence suggesting that increased sugar intake can lead to development of type 2 diabetes.

One study performed by Johnson et al. studied effect of fructose consumption on development of type 2 diabetes and obesity. They hypothesized that fructose can induce hyperuricemia which can lead to development of metabolic syndrome. It was found that high amount of fructose consumption did result in increased in serum uric acid levels. However, high fructose diet did not have significant effect on metabolic syndrome. At this point, evidence suggest that sugar consumption does not have much effect on development of diabetes. Findings of this study concludes that effects of sugars are entirely due to the calories it provides. Too much calorie consumption seems like the cause of obesity and diabetes and not sugar. Risk of diabetes development can be reduced by decreasing amount of calorie consumption and losing weight.

Practice Pearls:

  • There is a lack of evidence that increased sugar consumption leads to increase risk of developing type 2 diabetes.
  • There is also no evidence that sugar consumption in either liquid or solid form can increase appetite, decrease satiety, or cause diabetes.
  • Type 2 diabetes risk can be decreased by reducing total amount of calories consumption and not just by reduction in sugar amount.

Kahn R, Sievenpiper J. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes? Diabetes Care 37:957–962 March 2018.

Vidhi Patel, Pharm. D. Candidate 2018, LECOM School of Pharmacy